Treating Opioid Dependence: Two Ways to Peel a Carrot...

Top Medications Use Different Approaches, and Are Equally Effective

Two outpatient office based approaches to treating opioid addiction are equally safe and effective, conclude findings from a comparative study lead by researchers from the departments of psychology and population health at NYU Langone School of Medicine. The study compared the opioid antagonist extended release naltrexone to the more frequently prescribed buprenorphine-naloxone, an opioid agonist. The study also confirmed differences in the agonist/antagonist alternatives, chiefly that treatment with naltrexone requires patients to detoxify first, while treatment with buprenorphine carries some potential for abuse and diversion, and is associated with withdrawal symptoms at discontinuance. Prescribing regulations also differ for the 2 treatment approaches. The research was sponsored by the National Institute on Drug Abuse (NIDA) and was published online earlier this week in The Lancet.

The study evaluated a patient cohort of 570 adults who were opioid dependent, 66% of whom were men, and 82% primarily using heroin. They were randomized to receive either monthly naltrexone following detoxification, or daily buprenorphine started as soon as possible. After 24 weeks, measures of opioid use, including relapse rate, were similar for both groups. Opioid craving was initially lower in the naltrexone group, but equivalent for both groups by 24 weeks. Implications of the “detox hurdle” were also noted, with 25% of the patients assigned to naltrexone therapy unable to receive it due to incomplete detox, vs 6% unable to start buprenorphine. Lead author Joshua Lee, MD, MSc, commented “What is now clear is how similar the outcomes are for those initiating treatment with either medication. Both medications are effective treatments for opioid use disorders versus counseling-only approaches or compared to placebo.”